Giant supraclavicular schwannoma with cutaneous involvement mimicking malignancy: a case report and review of literature

Abstract Background Schwannomas are benign peripheral nerve sheath tumors arising from Schwann cells. Although up to 45% occur in the head and neck region, involvement of the supraclavicular region with cutaneous ulceration is extremely uncommon. Case presentation A 32-year-old male presented with a progressively enlarging left supraclavicular swelling associated with skin thinning and serous discharge. Imaging revealed a well-defined heterogeneously enhancing multi-nodular lesion with satellite nodules. Fine-needle aspiration cytology was suggestive of a benign peripheral nerve sheath tumor/schwannoma based on spindle cell morphology and nuclear palisading. The patient underwent wide local excision with removal of involved skin followed by local advancement flap reconstruction. Histopathological examination confirmed a benign schwannoma demonstrating Antoni A and Antoni B areas with nuclear palisading. Immunohistochemistry showed strong S100 and SOX10 positivity with a low Ki-67 index (< 2%). The satellite nodules demonstrated identical benign schwannomatous morphology. Conclusion Supraclavicular schwannomas with cutaneous involvement are rare and may present diagnostic and surgical challenges. Complete surgical excision with appropriate soft tissue reconstruction remains the treatment of choice and prevents recurrence. The follow-up period of 6 months showed no evidence of recurrence.